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Adherence to Dietary Recommendations after One Year of Intervention in Breast Cancer Women: The DIANA-5 Trial.
Bruno, E, Krogh, V, Gargano, G, Grioni, S, Bellegotti, M, Venturelli, E, Panico, S, Santucci de Magistris, M, Bonanni, B, Zagallo, E, et al
Nutrients. 2021;(9)
Abstract
The Diet and Androgen-5 (DIANA-5) trial aimed at testing whether a dietary change based on the Mediterranean diet and on macrobiotic principles can reduce the incidence of breast cancer (BC)-related events. We analyzed the adherence to the DIANA-5 dietary recommendations by randomization group after 1 year of intervention. We evaluated the association between dietary adherence and changes in body weight and metabolic syndrome (MS) parameters. BC women aged 35-70 years were eligible. After the baseline examinations, women were randomized into an intervention group (IG) or a control group (CG). A total of 1344 BC women (689 IG and 655 CG) concluded the first year of dietary intervention. IG showed greater anthropometric and metabolic improvements compared to CG. These changes were significantly associated with increased adherence to the dietary recommendations. Women who increased recommended foods consumption or reduced discouraged foods consumption showed an Odds Ratio (OR) of 1.37 (0.70-2.67) and 2.02 (1.03-3.98) to improve three or more MS parameters. Moreover, women in the higher category of dietary change showed a four times higher OR of reducing body weight compared to the lower category (p < 0.001). The DIANA-5 dietary intervention is effective in reducing body weight and MS parameters.
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Psychological mediators of exercise adherence among older adults in a group-based randomized trial.
Beauchamp, MR, Liu, Y, Dunlop, WL, Ruissen, GR, Schmader, T, Harden, SM, Wolf, SA, Puterman, E, Sheel, AW, Rhodes, RE
Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2021;(3):166-177
Abstract
OBJECTIVE To examine the psychological mediators of exercise adherence among older adults in a group-based physical activity randomized controlled trial. METHOD Older adults (≥65 years) were randomized to one of three conditions as part of the "GrOup-based physical Activity for oLder adults" (GOAL) randomized controlled trial. These included similar age same gender (SASG) and similar age mixed gender (SAMG) exercise programs that were informed by the tenets of self-categorization theory, and a "standard" mixed age mixed gender (MAMG) exercise program. Participants represented a subgroup (n = 483, Mage = 71.41 years) from the larger trial (n = 627) who completed measures of the trial's putative psychological mediators (i.e., group cohesion and affective attitudes) over the course of the 24-week exercise programs. RESULTS Piecewise latent growth modeling revealed different trajectories between participants in the two intervention conditions (SASG, SAMG) when compared with the comparison MAMG condition with regard to perceptions of group cohesion and affective attitudes. Results of subsequent cross-lagged panel modeling revealed that better program adherence in the two intervention conditions, when compared with the referent MAMG condition, was mediated by perceptions of group cohesion. CONCLUSIONS The findings provide insight into how the two intervention programs differentially strengthened perceptions of group cohesion and affective attitudes over time. Consistent with self-categorization theory, the results also shed light on the role of group cohesion, in particular, as a psychological mechanism of action to promote older adults' exercise adherence behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention.
Sheshadri, A, Kittiskulnam, P, Delgado, C, Sudore, RL, Lai, JC, Johansen, KL
American journal of nephrology. 2021;(5):420-428
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Abstract
INTRODUCTION A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. METHODS Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26-32: ambiguous impairment, 21-25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. RESULTS One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: -620 [95% CI -174, -1,415], MCI: -1,653 [95% CI -120, -3,187]); less improvement in SPPB (ambiguous: -0.22 points [95% CI -0.08, -0.44], MCI: -0.45 [95% CI -0.13, -0.77]); and less improvement in PF (ambiguous: -4.0 points [95% CI -12.2, 4.1], MCI: -14.0 [95% CI -24.9, -3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: -0.54 [95% CI -1.27, 0.19], MCI: -0.97 [95% CI -0.37, -1.58]) and PF (ambiguous: -3.3 [95% CI -6.5, -0.04], MCI: -10.5 [95% CI -18.7, -2.3]). DISCUSSION/CONCLUSION Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.
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Adherence and Dietary Composition during Intermittent vs. Continuous Calorie Restriction: Follow-Up Data from a Randomized Controlled Trial in Adults with Overweight or Obesity.
Pannen, ST, Maldonado, SG, Nonnenmacher, T, Sowah, SA, Gruner, LF, Watzinger, C, Nischwitz, K, Ulrich, CM, Kaaks, R, Schübel, R, et al
Nutrients. 2021;(4)
Abstract
Although intermittent calorie restriction (ICR) has become popular as an alternative weight loss strategy to continuous calorie restriction (CCR), there is insufficient evidence on diet quality during ICR and on its feasibility over longer time periods. Thus, we compared dietary composition and adherence between ICR and CCR in a follow-up analysis of a randomized trial. A total of 98 participants with overweight or obesity [BMI (kg/m2) 25-39.9, 35-65 years, 49% females] were randomly assigned to ICR, operationalized as a "5:2 diet" (energy intake: ~100% on five non-restricted (NR) days, ~25% on two restricted (R) days), or CCR (daily energy intake: ~80%). The trial included a 12-week (wk) intervention phase, and follow-up assessments at wk24, wk50 and wk102. Apart from a higher proportion of energy intake from protein with ICR vs. CCR during the intervention (wk2: p < 0.001; wk12: p = 0.002), there were no significant differences with respect to changes in dietary composition over time between the groups, while overall adherence to the interventions appeared to be good. No significant difference between ICR and CCR regarding weight change at wk102 was observed (p = 0.63). However, self-reported adherence was worse for ICR than CCR, with 71.1% vs. 32.5% of the participants reporting not to or only rarely have followed the regimen to which they were assigned between wk50 and wk102. These results indicate that within a weight management setting, ICR and CCR were equivalent in achieving modest weight loss over two years while affecting dietary composition in a comparable manner.
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The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial.
Rodrigues, IB, Wang, E, Keller, H, Thabane, L, Ashe, MC, Brien, S, Cheung, AM, Funnell, L, Jain, R, Loong, D, et al
PloS one. 2021;(9):e0257742
Abstract
BACKGROUND Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake. METHODS This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants' and providers' experience with MoveStrong, adaptations to the model based on participant's and provider's experience, and program fidelity. RESULTS We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design. CONCLUSIONS Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.
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Attendance Rate in Patients with Diabetic Macular Edema Receiving Short Messages.
Kumar, G, Velu, S, Prakash, VJ, Kumar, S, Sivaprasad, S, Sharma, A, Raman, R
Ophthalmology. Retina. 2021;(10):1054-1056
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Longitudinal changes in Mediterranean diet and transition between different obesity phenotypes.
Konieczna, J, Yañez, A, Moñino, M, Babio, N, Toledo, E, Martínez-González, MA, Sorlí, JV, Salas-Salvadó, J, Estruch, R, Ros, E, et al
Clinical nutrition (Edinburgh, Scotland). 2020;(3):966-975
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BACKGROUND & AIMS Little is known about the impact of specific dietary patterns on the development of obesity phenotypes. We aimed to determine the association of longitudinal changes in adherence to the traditional Mediterranean diet (MedDiet) with the transition between different obesity phenotypes. METHODS Data of 5801 older men and women at high cardiovascular risk from PREDIMED trial were used. Adherence to MedDiet was measured with the validated 14p-Mediterranean Diet Adherence Screener (MEDAS). Using the simultaneous combination of metabolic health- and body size-related parameters participants were categorized into one of four phenotypes: metabolically healthy and abnormal obese (MHO and MAO), metabolically healthy and abnormal non-obese (MHNO and MANO). Cox regression models with yearly repeated measures during 5-year of follow-up were built with use of Markov chain assumption. RESULTS Each 2-point increase in MEDAS was associated with the following transitions: in MAO participants, with a 16% (95% CI 3-31%) greater likelihood of becoming MHO; in MHO participants with a 14% (3-23%) lower risk of becoming MAO; in MHNO participants with a 18% (5-30%) lower risk of becoming MHO. In MANO women, but not in men, MEDAS was associated with 20% (5-38%) greater likely of becoming MHNO (p for interaction by gender 0.014). No other significant associations were observed. CONCLUSIONS Better adherence to the traditional MedDiet is associated with transitions to healthier phenotypes, promoting metabolic health improvement in MAO, MANO (only in women), and MHO, as well as protecting against obesity incidence in MHNO subjects.
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The influence of mobile phone-based health reminders on patient adherence to medications and healthy lifestyle recommendations for effective management of diabetes type 2: a randomized control trial in Dhaka, Bangladesh.
Yasmin, F, Nahar, N, Banu, B, Ali, L, Sauerborn, R, Souares, A
BMC health services research. 2020;(1):520
Abstract
BACKGROUND In 2017, 80% of 425 million adults with diabetes worldwide were living in low and middle-income countries. Diabetes affected 6.9 million adults in Bangladesh and accounted for 3% of the country's total mortality. Proper management of diabetes is the key to positive health outcomes. This study investigated how mobile phone-based health intervention could increase patient adherence and thereby improve the disease outcomes for diabetes type 2 in Bangladesh. METHODS A mobile phone-based health project (including mobile phone reminders and 24/7 call center) was implemented in Dhaka District, Bangladesh from January to December 2014. A randomized control trial was carried out, recruiting randomly in intervention and control groups among the patients receiving treatment for type 2 diabetes at the Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. A total of 320 patients from both groups at baseline and 273 at endline were interviewed. RESULTS A significant improvement in patient adherence to diet, physical exercise, the cessation of use of tobacco and betel nut, and blood glycaemic control was found in the intervention group, whereas no such significant improvement was found in the control group. Cost and other co-morbidities were found to be the main reasons for non-adherence. CONCLUSION A mobile-health intervention should be considered as an additional option for non-communicable disease programs.
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Health education improves referral compliance of persons with probable Diabetic Retinopathy: A randomized controlled trial.
Khair, Z, Rahman, MM, Kazawa, K, Jahan, Y, Faruque, ASG, Chisti, MJ, Moriyama, M
PloS one. 2020;(11):e0242047
Abstract
OBJECTIVE Lack of awareness about Diabetic Retinopathy (DR) is the most commonly cited reason why many persons with type 2 diabetes are non-compliant with referral instruction to undergo retinal screening. The purpose of this study was to evaluate the efficacy of a culturally, geographically and socially appropriate, locally adapted five-month-long health education on referral compliance of participants. METHOD A prospective randomized, open-label parallel group study was conducted on persons with type 2 diabetes who underwent basic eye screening at a diabetes hospital between September 2017 and August 2018. Participants who were noncompliant with referral instruction to visit a hospital for advanced DR management were randomly divided into health education intervention group (n = 143) and control group (n = 156). Both groups received information regarding DR and referral instruction at the diabetes hospital. The intervention group was provided personalized education followed by telephonic reminders. The primary endpoint was 'increase in referral compliance' and the secondary endpoint was 'increase in knowledge of DR'. Multivariate logistic regression model was used to identify significant predictors of compliance to referral. RESULTS A total of nine participants dropped and 290 completed the post intervention survey. The compliance rate in intervention group was found to be significantly higher than the control group (64.3% vs 28.2%; OR 4.73; 95% CI 2.87-7.79; p<0.001). Participants in the intervention group acquired better knowledge on DR (p<0.05). Apart from intervention, referral compliance rate was also found to be significantly associated with participants' self-perception of vision problem (OR 2.02; 95% CI 1.02-4.01; p = 0.045) and participants' income (OR 1.24; 95% CI 1.06-1.44; p = 0.008). DISCUSSION Our results suggest that intensive health education on DR should be integrated with diabetes education as it may result in significantly improved referral compliance. Outcomes may be sustainable if interventions are institutionalized at referral point. TRIAL REGISTRATION Clinical Trials.gov (Registration # NCT03658980); https://clinicaltrials.gov/ct2/show/NCT03658980.
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Adherence to Mediterranean Diet or Physical Activity After Bariatric Surgery and Its Effects on Weight Loss, Quality of Life, and Food Tolerance.
Gils Contreras, A, Bonada Sanjaume, A, Becerra-Tomás, N, Salas-Salvadó, J
Obesity surgery. 2020;(2):687-696
Abstract
OBJECTIVE To assess whether a healthy dietary pattern or physical activity after bariatric surgery mediates the effects of surgery on weight loss, the quality of life, or food tolerance. METHODS A prospective observational study conducted in the context of a randomized controlled trial. We assessed the extent to which increasing or decreasing adherence to the Mediterranean diet (MedDiet)-assessed by MEDAS (Mediterranean Diet Adherence Screener)-and of increasing or decreasing physical activity (PA)-assessed with the Short Questionnaire of International PA (IPAQ-Short Q)-after bariatric surgery affected changes in weight, body mass index (BMI), quality of life (Moorehead-Arlet Questionnaire), and food tolerance (Suter test). Assessments were recorded at baseline and quarterly up to 12 months of surgery. RESULTS Seventy-eight morbidly obese participants undergoing bariatric surgery were assessed up to 1 year after surgery. Those individuals who increased adherence to MedDiet showed a significantly higher mean of total weight loss percentage than those who decreased or maintained their adherence during follow-up: 37.6% (35.5-39.8) versus 34.1% (31.8-36.5) (p = 0.036). No significant differences were observed in changes in weight or BMI comparing individuals who increased their PA versus those who maintained or decreased PA, nor in quality of life or food tolerance between those individuals who increased versus those who decreased adherence to MedDiet or PA during the follow-up. CONCLUSIONS After bariatric surgery, morbidly obese subjects present greater weight loss if they adhere to the MedDiet. PA after surgery is not associated with the magnitude of weight loss nor the quality of life and tolerance to diet.